The Evolving Role of Axillary Lymph Node Fine-Needle Aspiration in the Management of Carcinoma of the Breast
The Evolving Role of Axillary Lymph Node Fine-Needle Aspiration in the Management of Carcinoma of the Breast
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DOI：
10.1002/cncy.20152
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发表时间：
2011-10-25
影响因子：
3.4
通讯作者：
Colgan, Terence J.
中科院分区：
文献类型：
--
作者：
Chang, Martin C.;Crystal, Pavel;Colgan, Terence J.
背景：图像引导下的细针穿刺（FNA）腋窝淋巴结（LN）评估乳腺癌的研究显示出高特异性，但敏感性不一。本研究的目的是根据临床放射学结果评估腋窝LN FNA的性能，并记录治疗如何根据FNA结果而变化。方法：研究队列包括连续4年的腋窝LN FNA病例，其中后续治疗是已知的。临床放射学评估分为“低怀疑”或“高怀疑”，细胞病理学结果分为“阳性”、“阴性”或“不确定”。以手术病理结果为“金标准”，计算每个患者的测试表现。分析腋窝LN FNA对后续管理决策的影响。结果：163例患者中，腋窝FNA阳性94例（58%），阴性55例（34%），非典型/非诊断性14例（8%）。临床放射学评估“高度怀疑”的阳性预测值（PPV）为88%，而“低怀疑”评估的阴性预测值（NPV）仅为68%。腋窝LN FNA的PPV和NPV分别为98.7%和81.8%。尽管所有fna阳性病例均采用手术治疗，但94例fna阳性病例中有26例推迟了手术，包括11例新辅助治疗。其余大多数（68例中65例）fna阳性患者均未行前哨淋巴结活检。结论：图像引导LN FNA对乳腺癌淋巴结累及具有高度敏感性和特异性，在保留前哨淋巴结活检和分诊病例进行全身治疗方面均发挥作用。癌症（癌症细胞酚）2011;119:328-34。(C) 2011年美国癌症协会。
BACKGROUND: Image-guided fine-needle aspiration (FNA) studies of axillary lymph nodes (LN) to evaluate breast carcinoma have shown high specificity but variable sensitivity. The purposes of this study were to evaluate the performance of axillary LN FNA depending on clinicoradiologic findings and to document how treatment varied according to FNA results. METHODS: The study cohort consisted of consecutive axillary LN FNA cases over a 4-year period, in which subsequent treatment was known. Clinicoradiologic assessment was classified as "low suspicion" or "high suspicion" and cytopathologic findings as "positive," "negative," or "indeterminate". The test performance for each, using surgical pathology outcome as the "gold standard," was calculated. The impact of axillary LN FNA on subsequent management decisions was analyzed. RESULTS: Of the 163 cases, axillary FNA was positive in 94 of 163 (58%), negative in 55 of 163 (34%), and atypical/nondiagnostic in 14 of 163 (8%). A clinicoradiologic assessment of "high suspicion" had a positive predictive value (PPV) of 88%, whereas a "low suspicion" assessment had a negative predictive value (NPV) of only 68%. In contrast, the PPV and NPV of axillary LN FNA were 98.7% and 81.8%, respectively. Whereas all of the FNA-nonpositive cases were managed surgically, surgery was deferred in 26 of 94 of the FNA-positive cases, including 11 cases of neoadjuvant treatment. Most of the remaining (65 of 68) FNA-positive patients were spared sentinel lymph node biopsy. CONCLUSIONS: Image-guided LN FNA is highly sensitive and specific for lymph node involvement by breast carcinoma and plays a role both in sparing sentinel lymph node biopsy and in triaging cases for systemic therapy. Cancer (Cancer Cytopathol) 2011;119:328-34. (C) 2011 American Cancer Society.